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Page: of 213
i50
mee ws we See —‘TotallNo: le eee Yearly No ae Date of Oe oeats Jade L£.
Name of Deceased hic eC rd ro Khe Ssh CL. Milby Je.
OMaried Ci Single Widowed C0 Divorced reepatie CsA cinta (What Race)
us! ue 1d0ow
Residence G Ss. Zz hu i of Cc a) AU (4 S ‘. or. of t Age of Husband or Wife (if living).......
Charge to. (Uskler ae Sah rsabd. Gecintete Buneralst Lanta A
mplete Funeral (except outlays
Bide OT capa ee Lue. lig r,
Casket 4/0
Order given by Lg hlek £: v, br SOAd B Burial Vault or Box. Cemen) va LLALELE.. Si
infor © (State Kind)
How Secured 7) aa Embalming Body (Name of Embalmer)
Barber, Sijc05 202 Hair Dressing, $
If Veteran, N f W. : ‘
ie Ae Lh Pee ae Dressing Body, $.....----Underwear, §.....--------. . ---------Occupation. ZZ6.AS€. Wile. ae Suit or Dress
(Social Security Number) I (State Kind and Color)
Employer and Address Slippers, $ Hose, $
é = Folding Chairs, $....-.-.Tarpatiin: 678.. 1
Date at Death ase (Day) Liles’ Zod, G. Candelabrum, $......------Candles, $._....----------+:. . ------+-Date of BirthZZ Wias/ AE. ISD. Sace 2h.-2 tee & Peeks =e. (¥__. Door Spray, 9.. Gloves, $ i
(Day) (Fr) (Mos.)
Name of A oes WILE Ce Vege. CAL Funeral Car, $...Ambulance, $....-pa
’ Limousines to Cemetery. el is Wloka ane oe .
His Birthplace U. nN af Van Extra Limousines @$ RIS Pla
waiden'Namie of Mothend-.L42<a 7, Autos to R. R. Station @$ Riees.
Getting Remains from x . et
Her Birthplace L oJ).2 7). Taking Remains to. ...-.---------------eeeee ann
Date of Funeral ae Cae he hse atl Trip to Coroner Tata [bc st seers aman clan Biases Ee
(Date) pale West Week) G . Delivering Box t0..-.----.--------------ssesseseeeeeeeneeecsettee. feeeeees
Services at tHe Vf. CK.COVER. el . Deliver PlOWers C068 a Neceeeeeeeees cess ad ceed [acters
/ ) é Removal Charges. 5 ccd echt ant eel renee
Clergyman oa : Cae Vy. & iL Procuring Burial Permit se re fo
te umber an istrict,
Religion of the Deceased __. Certif. Copies of Death Certificates No a a ae
tate sician’s or Coroner's)
Birthplace Llevasla Pall Bearer Service, $... Use of Chapel, §.-.. _—
Gross Total for Sales Tax ss
Rosided in the Gite nist ee ee Ne pe ee eee. fle SCL
eee e S oe (or U.S. or City coy nty) fears) (Months) Outlay for Lot@ LMC. DQG pl Be. ake IGS Lak
Place of Death Le, KRG l LC #1 Cremation. 58 ee ee ee ee
Capse of Death Yuamaus Cobh. Claw cidatan Flowers, $< Palms, $...--.-Matting, $...-.
Ta 49 ug) /} / Ps + of Rental of Tent, $.... of Temporary Vault, $..... . ..-.-tributory art es. CCL 412228 Opening of Grave or Tomb CLO SLAG-...\. _----2
Je las Fras é <3 Lining Grave, $....-.--Lowering Device, $....----. . -----Outlay for Shipping Charges....-------------------4y . . "
Certifying Physician. TOS. fe ah abe, tha . dD Clergymen, 3/0 singers, $....Organist, PS ee
His Address > We or Motot { Tickets, $......plane Service, $.....-. ----Motor Telegr., Phone, Cable or Radio Charges......-----\. -----Ship t Remains to } «Cash AdVanced..n...--.--s-ccecescessseeeseecsecserereenensesentacea. . teeece
Size of Casket 360 a y=) Ne Sle e L -Lam dsk, ,Mut of town Funeral Director’s Charges....-.-----. . -----(Sate Color and Kujnber} Personal Service.. sco-.qecneodpc-gessecensapseeteggecpeewepranee. . seen
pn . yg ee hes HAE esa Zeenat al Wy£e ka
pe id t L7_&: S “op Chea ie eee line Death Notices in Papers.7.....-. . .--Lot No Zi of aie 2 a tk Gee hy De
Grave No....s94 Te
Section No Sales Tax.. ; =
Total Footing of Bill $}. _Z.
Block No Less $. . __
: Owner Balance Save
ee Entered into Ledger, page......or below.
Misc
Misc